Most Relevant Information
Provider Data
| NPI Number: | 1003177296 |
| Provider Name: | JEREMY DANIEL EDGERLY O.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 152W00000X |
| Specialty: | Optometrist |
| License Number: | S-C78 |
Most Important Dates
| Enumeration Date: | 06/04/2012 |
| Last Updated: | 07/24/2012 |
Provider Practice Location
1400 WALL ST
CULLMAN
AL
350556011
Practice Location Phone/Fax
| Phone: | 2567370124 |
| Fax: |
Provider Mailing Location
1400 WALL ST
CULLMAN
AL
350556011
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |